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Oregon health officials have provided the state’s hospitals with an interim crisis care tool to help prioritize treatment if they reach a point when critical care beds, specialized equipment and other resources become scarce due to COVID-19 admissions.
The Oregon Health Authority (OHA) said in a release that hospitals may active crisis standards of care if resources are limited, the number of patients who need critical care exceeds capacity and if there is no option to transfer patients to other facilities.
The tool may be implemented assuming the hospital has taken steps to extend capacity to deliver care, including stockpiling supplies, delaying non-urgent care and repurposing existing beds and staff that are not typically used to provide critical care.
Hospitals may also use a tool of their own consistent with Oregon’s Principles in Promoting Health Equity in Resource Constrained Events.
Using the interim triage tool, if health care resources are sufficient all patients who can potentially benefit from treatment will be offered care and if resources are insufficient all patients will be individually assessed according to the best available objective medical evidence.
The tool says no one will be denied care based on stereotypes, assumptions about any individual’s quality of life, judgment about an individual’s “worth” based on the presence or absence of disabilities and that care decisions should be based on the likelihood of survival to hospital discharge.
“Under Oregon’s interim crisis care standards, state health officials expect providers to treat all patients with respect, care and compassion. Hospital clinicians may not base care decisions on an individual’s use of past or future medical or social resources. They should apply reasonable modifications to any triage scoring criteria when considering individuals with underlying disabilities or certain underlying health conditions,” the release stated. “Triage decisions will be made without regard to morally or scientifically irrelevant considerations such as income, race, ethnicity, gender identity, sexual orientation, immigration status, health insurance coverage or other factors.”
The new tool was based on several existing triage tools published in Arizona, Massachusetts and Washington state and Oregon health authorities made adjustments according to the state’s health equity principles of non-discrimination, patient-led decision making and transparent communications.
State health officials also consulted medical professionals, ethicists and disability advocates before releasing the tool.
“Right now, we want to put a triage tool in the hands of clinicians who are likely to face very difficult decisions in the coming weeks, as the Omicron variant takes its toll and puts more patients in the hospital. This interim tool isn’t perfect, but it ensures that clinicians can be confident they are using criteria firmly grounded in Oregon’s values of non-discrimination and health equity as they face these gut-wrenching decisions,” OHA’s chief medical officer Dr Dana Hargunani said in a statement.
The OHA said Oregon is committed to developing a permanent tool based on broader community input.
This measure was taken as hospitalizations continue to climb in states around the nation, due to the omicron variant of the coronavirus.
On Friday, Oregon reported 10,451 new confirmed and presumptive cases and 33 new deaths.
In a separate statement announcing the news, the OHA said that Dr. Peter Graven – the director of the Oregon Health & Science University Office of Advanced Analytics – had estimated the expected surge could lead to more than 1,650 hospitalized patients with COVID-19 by the end of the month.
The number of hospitalized patients with COVID-19 in Oregon is 625 – an increase of 37 from Thursday.
There are 47 available adult ICU beds out of 660 total and 219 available adult non-ICU beds out of 4,075.
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